臺灣博碩士論文加值系統

摘要
研究背景:
我國已進入老化人口，不只要活的更長久，更要追求好的生活品質。文獻提及咀嚼功能不良會影響整體健康狀況甚至影響心理人際關係，但膺復狀況及需求與生活品質之關係尚未有研究證明。
研究目的：
本研究目的是希望能找出影響成年人膺復狀況及膺復需求與生活品質的預測因子及相關影響因素。
研究方法：
本研究調查台東縣及南台灣四縣市原住民與漢民族成年人膺復狀況及需求，以完成問卷及口檢者為有效樣本，調查時間為2003年10月至2004年2月。有效樣本共510位，其中原住民169人(33.80%)，漢民族341人(66.20%)。將人口學變項、膺復狀況及需求與生活品質資料建檔，其中以Short Form-36量表量測生活品質，以JMP統計套裝軟體，進行資料統計分析。
研究結果：
原住民男性擁有膺復物的比例（13.51％），不到女性的一半（29.47％）；50-64歲（32.28％）及大等於65歲（46.03％）老年者擁有膺復物顯著高於18-34歲（17.74％）年輕者；原住民有膺復者只有20%，漢民族高達40%，原住民幾乎是漢民族的一半，漢民族隨年紀增加而膺復比率顯著增加，原住民在年齡層無顯著差異。膺復需求的比較上，原住民（52%）是漢民族（24%）的2.57倍。
比較不同膺復狀態需求方面，在漢民族，只要有膺復或需求，其生理健康(PCS, physical component scale）皆顯著較差，原住民則在已有膺復仍有需求者才顯著較差；心理健康(MCS, mental component scale）方面，只有漢民族在未有膺復仍有需求者為顯著較差，原住民則無顯著差異；固定義齒與生理健康PCS有顯著正相關影響，而局部活動義齒及全口活動義齒為強烈負相關。比較膺復型態與心理健康MCS，只有原住民在局部活動義齒達顯著正相關。膺復型態需求與生理健康的影響，局部活動義齒及全口活動義齒達顯著負相關。膺復型態需求與心理健康只有固定義齒需求達顯著負相關。原住民及漢民族剩餘齒數超過20顆的生理健康，顯著高於未超過20顆者，心理健康則只有漢民族達顯著。原住民TMJ症狀是漢民族的3.58倍，未曾膺復且無需求者是已有膺復仍有需求者的不到二分之一有TMJ症狀（OR=0.44）。
結論：
　　膺復狀況、膺復型態、膺復需求的不同對生活品質有顯著
影響，對生理健康的衝擊顯著較大，心理健康的影響，則較不顯著，
只有在漢民族達顯著，社經地位越高，衝擊越大，固定膺復優於活動
膺復，原住民膺復的比率低，而膺復需求的比率高。本研究結果可以
提供各界了解原住民漢民族間膺復狀況及需求之差異，及對生活品質
之影響，以利未來公共牙醫政策之參考。

Abstract
Background:
The population proportion of elderly has been growing higher in Taiwan. People pursue not only longer life, but also better quality of life (QOL). Previous research pointed out that chewing dysfunction could affect general body health, mental health, or even social relationship. However, there were limited studies on the correlation of prosthetic status and prosthetic needs with the quality of life.

Study objective:
This study aimed to investigate the association between prosthetic status and prosthetic needs with the quality of life (QOL).

Study methods:
Our survey included Taitung and four other counties of Southern Taiwan. People who have both finished questionnaire and received oral examinations were considered as study samples with information on the prosthetic status, prosthetic needs, and the quality of life were. There were totally 510 participants (169 were aborigines and 341 were Han adults). QOL was evaluated by SF-36. The JMP Statistics software has been utilized to conduct the statistical analysis.

Results:
For prosthetic status, the restored rate of men (13.51%) was less than a half of that of women (29.47%) in aborigines. For people older than 65 y/o, the restored rate (46.03%) was significant higher than that people aged 18-34 y/o(17.74%). Only about 20% aboriginal adults have been restored by prosthetic treatment; while Han adults, up to 40%. The aboriginal restored rate was almost half of Han’s. The restored rate ascended as the age increased in Han adults, but the same phenomenon doesn’t exist in aboriginal adults. The prosthetic needs for aborigines were up to 52%, but for Hans were only 24%. Aborigines were 2.57 times as compared with Han.
After comparing the different prosthetic status and need, it was significant and negative influence to physical component scale (PCS) for Hans who just have been restored or have prosthetic need. But for aborigines, it was significant and negative influence only for people who have been restored and have persisted in having prosthetic need. The mental health that calculated by mental component scale(MCS) in SF-36 was just only to be influenced significantly for the people who have never been restored and persisted in having prosthetic need in Hans. But there is no significant difference in aborigines.
The fixed prosthesis was apparently positive to physical health, but the removable was negative. It was apparently positive to mental health only for aborigines having partial removable denture. It was negative to physical health for those having removable denture need. It was also negative to mental health for those having fixed denture need. The people whose remained teeth over 20 were better in physical condition than those under 20 in both tribes, but the mental impact just occurred in Hans. There were 3.58 times more possibilities for aborigines to have TMJ syndrome as compared with Hans .

Conclusion:
The differences in prosthetic status, prosthetic type, and prosthetic needs have significant influence to QOL. This study indicated that the impact on the quality of life by prosthetic status and prosthetic need were higher in physical than in mental. The mental impact was significant only on Hans. The higher the socioeconomic was, the stronger the impact would be. Fixed prosthesis was better than removable prosthesis.
This study found the differences in the association between the quality of life and prosthetic status as well as prosthetic need in aborigines and Hans. It also indicated the important factors that influence QOL. The result could be considered as a reference in making dental public health policy in the future.


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中文摘要………………………………………………………………Ⅰ
英文摘要………………………………………………………………Ⅳ
第一章 緒論…………………………………………………………1
第一節 研究背景………………………………………………… 1
第二節 研究目的………………………………………………… 3
第二章 文獻探討…………………………………………………… 5
第一節 口腔膺復需求…………………………………………… 5
第二節 族群間膺復需求與口腔狀況之比較……………………6
第三節 影響膺復狀況之因素……………………………………8
第四節 生活品質與口腔狀況之相關影響因子探討……………9
第五節 假牙膺復需求相關心理之影響…………………………16
第三章 材料與方法……………………………………………… ….18
第一節 研究對象…………………………………………………18
第二節 研究設計…………………………………………………18
第三節 研究工具…………………………………………………19
第四節 研究架構………………………………………………… 22
第四章 研究結果……………………………………………….23
第一節 社會人口學基本資料…………………………………… 23
第二節 社會人口學與膺復狀況及膺復需求之關係………………24
第三節 影響膺復型式及膺復型式之重要因子……………………25
第四節 人口學與生活品質…………………………………………25
第五節 膺復狀態及膺復需求與生活品質…………………………27
第六節 不同膺復型式及膺復型式需求與生活品質之關係…… 30
第七節 餘齒數與生活品質的關係…………………………………32
第八節 影響TMJ症狀的相關因子…………………………………32第五章 討論………………………………………… 34
第一節 膺復狀態與膺復需求之分析………………………… 34
第二節 人口學與生活品質的關係……………………………… 35
第三節 膺復狀態及膺復需求與生活品質之關係……………… 37
第四節 膺復型式及需求與生活品質之關係…………………… 39
第五節 剩餘齒數與生活品質的關係…………………………… 41
第六節 影響TMJ症狀的相關因子……………………………… 42
第六章 結論及建議…………………………………… 43
第一節 結論…………………………………………………………43
第二節 建議…………………………………………………………45
參考文獻……………………………………………………47


表格目錄
表1-1西澳人口學變項中市區、鄉村地區、偏遠地區全口無牙率之比較53
表1-2 西澳全口無牙率對數迴歸分析預測之coefficient………………… 53
表 2-1 世界各國老年人全口無牙率之比較一…………………………… 54
表2-2 世界各國老年人全口無牙率之比較二…………………………… 55
表2-3 界各國老年人全口無牙率之比較三……………………………… 56
表3台東縣及南台灣成年人研究對象社會人口學基本資料…………… 57
表4台東縣及南台研究對象社會人口學與膺復狀況之比較………………58
表 5影響膺復狀態(prosthetic status)重要因子之迴歸比較………… 59
表6台東縣及南台灣研究對象社會人口與膺復狀況及膺復需求之比較.. 60
表7影響膺復需求(prosthetic need)重要因子之迴歸比較………………61
表8影響固定膺復(fixed prosthesis)重要因子之迴歸比較…………… 62
表9影響局部活動膺復(partial removable prosthesis)重要因子之迴歸比較……………………………………………………………………………… 63
表10影響全口活動膺復(complete removable prosthesis)重要因子之迴歸比較…………………………………………………………………………… 64
表11影響全口活動膺復需求(complete removable prosthesis)重要因子之迴歸比較……………………………………………………………………… 65
表12研究樣本個案簡表-36各層面分數描述……………………………… 66
表13人口學變項與身體功能(PF)之關係 ……………………………………67
表14人口學變項與健康問題引起的角色限制（RP） ………………………68
表15人口學變項與身體疼痛(BP)之關係 ……………………………………69
表16人口學變項與整體健康(GH)之關係 ……………………………………70
表17人口學變項與活力狀況(VT)之關係 ……………………………………71
表18人口學變項與社會功能(SF)之關係 ……………………………………72
表19人口學變項與因情緒問題而引起的角色限制（RE） …………………73
表20人口學變項與心理健康(MH)之關係 ……………………………………74
表21不同膺復狀態需求與身體功能(PF)之關係 ……………………………75
表22不同年齡層之不同膺復狀態需求與身體功能(PF)關係 ………………76
表23不同膺復狀態需求與健康問題所引起之角色限制（RP） ……………77
表24年齡層不同膺復狀態需求與健康問題所引起之角色限制（RP） ……78
表25不同膺復狀態需求與身體疼痛（BP）………………………………… 80
表26年齡層不同膺復狀態需求與身體疼痛(BP)關係……………………… 81
表27不同膺復狀態需求與整體健康（GH）………………………………… 83
表28年齡層不同膺復狀態需求與整體健康(GH)關係……………………… 84
表29不同性別不同膺復狀態需求與活力狀況（VT）……………………… 86
表30不同年齡層不同膺復狀態需求與活力狀況(VT)關係………………… 87
表31不同膺復狀態需求與社會功能（SF）……………………………… 89表32 年齡層及不同膺復狀態需求與社會功能(SF)關係比較……90
表33 不同膺復狀態需求與因情緒問題所引起之角色限制（RE）.92
表34年齡層及不同膺復狀態需求與因情緒問題所引起之角色限制(RE)關係……………………………………………………………93
表35 不同膺復狀態需求與心理健康（MH）…………………………95
表36 年齡層不同膺復狀態需求與心理健康(MH)關係………………96
表37性別年齡層及不同膺復狀態需求與生理健康(PCS)關係…… 98
表38不同膺復狀態需求與整體生理健康(PCS)之多元變異數分析
(multiple way ANOVA)……………………………………100
表38-1 原住民不同膺復狀態需求生理健康PCS相對於未曾膺復且無需求需求需求之顯著變項 ………………………………………101
表38-2　漢民族不同膺復狀態需求生理健康PCS相對於未曾膺復且無需求之顯著變項………………………………………… 101
表39年齡層及不同膺復狀態需求與整體心理健康(MCS)關係……102
表40不同膺復狀態需求與整體心理健康(MCS)多元變異數分析 (multiple way ANOVA)………………………………… 104
表40-1漢民族心理健康MCS相對於未曾膺復且無需求之顯著變項………………………………………………………………105
表41不同膺復型式與整體生理健康(PCS)之比較…………………106
表42不同膺復型式年齡層與整體生理健康(PCS)之比較…………107
表43膺復型態與綜合生理健康(PCS)之迴歸分析結………………109
表44不同膺復型式與心體生理健康(MCS)之比較…………………110
表45不同膺復型式年齡層與整體心理健康(MCS)之比較…………111
表46 膺復型態與綜合心理健康(MCS)之迴歸分析結………………113
表47不同膺復型式需求與整體生理健康(PCS)之比較……………114
表48不同膺復型式需求年齡層與整體生理健康(PCS)之分析……115
表 49 膺復型態需求與綜合生理健康(PCS)之迴歸分析………… 117
表50不同膺復型式需求與整體心理健康(MCS)之分析……………118
表51不同膺復型式需求年齡層與整體心理健康(MCS) 分析…… 119
表 52 膺復型態需求與綜合心理健康(MCS)之迴歸分析………… 121
表53 有無超過20顆剩餘齒與生活品質之比較……………………122
表54 TMJ症狀的相關變項因子………………………………………123
表55 影響TMJ症狀重要因子之迴歸……………………………… 125
表56 影響生活品質之顯著相關之重要變項…………………… 126
附錄一…………………………………………………………………127
附錄二………………………………………………………………..128
附錄三…………………………………………………………………131
Table Catalog
Table1-1 Comparison of percentage edentulism in urban, rural and remote
respondents by age-group Factors in Western Australia………...135
Table 1-2 co-efficient from the logistic regression analysis to examine
predictors of edentulism in Western Australia……………………135
Table2-1Comparison of percentag edentulism over the world …………136
Table2-2 Comparison of percentag edentulism over the world...…………. 137
Table2-3 Comparison of percentag edentulism over the world.….…...…….138
Table3 General demographic data of research amples ……………...139
Table4 General demographic comparison with prosthetic …………… 140
Table5 Logistic regression of influencing factors to prosthetic ………. 141
Table6 General demographic comparison with prosthetic needs……….142
Table7 Logistic regression of influencing factors to prosthetic need…143
Table8 Logistic regression of influencing factors to fixed prosthesis 144
Table9 Logistic regression of influencing factors to partial removable prosthesi145
Table10 Logistic regression of influencing factors to complete removable prosthesis………………………………………………………………...….146
Table11Logistic regression influencing factors to complete removable prosthesis………………………………………………………………...……...147
Tble12 Description of each part of Short Form-36 among samples… 148
Table13 Demographic description of PF………………………………….149
Table14 Demographic description of RP…………………………………150
Table15 Demographic description of BP……………………………….151
Table16 Demographic description of GH……………………………….152
Table17 Demographic description of VT………………………………...153
Table18 Demographic description of SF……………………………….154
Table19 Demographic description of RE………………………………….155
Table20 Demographic description of MH………………………………..156
Table21 Demographic description of PF with different prosthetic status & need……………………………………………………………………………..157
Table22 Agegroup description of PF with different prosthetic status & need.…………………………………………………………………………….158
Table23 Demographic description of RE with different prosthetic status & need……………………………………………………………………………..160
Table24 Agegroup description of RP with different prosthetic status & need……………………………………………………………………………..161
Table25 Demographic description of BP with different prosthetic status & need.…………………………………………………………………………....163
Table 26 Agegroup description of BP with different prosthetic status & need……………………………………………………………………………..164
Table27 Demographic description of GH with different prosthetic status & need……………………………………………………………………………..166
Table28 Agegroup description of GH with different prosthetic status & need………………………………………………………………………...…...167
Table29 Demographic description of VT with different prosthetic status & need.169
Table30 Agegroup description of VT with different prosthetic status & need…....170
Table31 Demographic description of SF with different prosthetic status & need.172
Table32 Agegroup description of SF with different prosthetic status &need….....173
Table33 Demographic description of RE with different prosthetic status & need….175
Table34 Agegroup description of RE with different prosthetic status & need …....176
Table35 Demographic description of MH with different prosthetic status &need.....178
Table36 Agegroup description of MH with different prosthetic status & need.........179
Table37 Agegroup with sex description of PCS with different prosthetic status & need.181
Table38 Multiple way ANOVA of Different prosthetic status & needs and PCS……………………………………………………………….….183
Table38-1 Multiple regression of aboriginalPCS to Different prosthetic status &
need ………………………………………………………………...184
Table39 Agegroup with sex description of MCS with different prosthetic status & need ………………………………………………………………...185
Table 40 Multiple ANOVA of Different prosthetic status & needs and MCS……………………………………………………………187
Table40-1 Multiple regression of Hans MCS to Different prosthetic….188
Table41 Description of different prosthetic type and sex………………..189
Table 42 PCS OF different prosthesis type in different agegroup …......190
Table 43 Multiple regression of PCS and Different prosthetic types …192
Table44 MCS of different prosthetic type and sex ………………….193
Table45 MCS OF different prosthesis type in different agegroup…….194
Table46 Multiple regression of MCS and Different prosthetic types …196
Table47 Different prosthetic types needs and PCS....................................197
Table48 Agegroup comparison of prosthetic types need and PCS…......198
Table49 Multiple regression of PCS and Different prosthetic types needs…..200
Table 50 Different prosthetic types needs and MCS…..............................201
Table 51 Agegroup comparison of prosthetic types need and MCS….. 202
Table52 Multiple regression of MCS and Different prosthetic types…..204
Table53 Correlation of QOL and remained teeth…....................................205
Table54 Related factors to TMJ …........................................206
Table55 Logistic regression of influencing factors to TMJ…............208
APPENDIX ONE…........................................................................ ................209
APPENDIX TWO…........................................................................... .............211
APPENDIX THREE........................................

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